Brett D Owens

Keller Army Community Hospital, ვესტ-პოინტი, New York, United States

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Publications (176)376.52 Total impact

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    ABSTRACT: Technical advances have allowed arthroscopic rotator cuff repair to supplant open repairs with similar outcomes. However, few data exist to support the theoretical decrease in complications with the arthroscopic technique. We used the Veterans Administration Surgical Quality Improvement Program database from the entire U.S. Veterans Administration system. We obtained perioperative data of all patients undergoing rotator cuff repair between 2003 and 2008. Single and multivariate analyses were performed to evaluate risk factors for perioperative complications associated with rotator cuff surgery. There were 6975 open rotator cuff repairs and 2918 arthroscopic rotator cuff repairs performed with similar patient age, gender breakdown, body mass index, and comorbidities. Complications occurred in the early postoperative period in 2.1% of the open repair group and 0.9% of the arthroscopic repair group (P < .0001). The prevalence of both superficial and deep wound infection was higher in the open group compared with the arthroscopic group (1% vs. 0.1% superficial, P < .0001; 0.3% vs. 0.1% deep, P = .11). Return to the operating room within the 30-day surveillance period occurred in 1.1% of the open repair patients compared with 0.5% of patients undergoing arthroscopic repairs (P < .0001). -Multivariate logistic regression analysis revealed that the arthroscopic group had a significantly lower risk of complications (P = .0001), a lower rate of superficial infection (P = .0002), a lower incidence of return to the operating room within 30 days (P = .007), and a lower risk of hospital readmission (P < .0001). Arthroscopic rotator cuff repair in the veteran population resulted in a lower incidence of perioperative complications compared with open repair. Published by Elsevier Inc.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 07/2015; DOI:10.1016/j.jse.2015.04.020 · 2.37 Impact Factor
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    ABSTRACT: Determining the magnitude of glenoid bone loss in cases of shoulder instability is an important step in selecting the optimal reconstructive procedure. Recently, a formula has been proposed that estimates native glenoid width based on magnetic resonance imaging (MRI) measurements of height (1/3 × glenoid height + 15 mm). This technique, however, has not been validated for use with computed tomography (CT), which is often the preferred imaging modality to assess bone deficiencies. The purpose of this project was 2-fold: (1) to determine if the MRI-based formula that predicts glenoid width from height is valid with CT and (2) to determine if a more accurate regression can be resolved for use specifically with CT data. Descriptive laboratory study. Ninety normal shoulder CT scans with preserved osseous anatomy were drawn from an existing database and analyzed. Measurements of glenoid height and width were performed by 2 observers on reconstructed 3-dimensional models. After assessment of reliability, the data were correlated, and regression models were created for male and female shoulders. The accuracy of the MRI-based model's predictions was then compared with that of the CT-based models. Intra- and interrater reliabilities were good to excellent for height and width, with intraclass correlation coefficients of 0.765 to 0.992. The height and width values had a strong correlation of 0.900 (P < .001). Regression analyses for male and female shoulders produced CT-specific formulas: for men, glenoid width = 2/3 × glenoid height + 5 mm; for women, glenoid width = 2/3 × glenoid height + 3 mm. Comparison of predictions from the MRI- and CT-specific formulas demonstrated good agreement (intraclass correlation coefficient = 0.818). The CT-specific formulas produced a root mean squared error of 1.2 mm, whereas application of the MRI-specific formula to CT images resulted in a root mean squared error of 1.5 mm. Use of the MRI-based formula on CT scans to predict glenoid width produced estimates that were nearly as accurate as the CT-specific formulas. The CT-specific formulas, however, are more accurate at predicting native glenoid width when applied to CT data. Imaging-specific (CT and MRI) formulas have been developed to estimate glenoid bone loss in patients with instability. The CT-specific formula can accurately predict native glenoid width, having an error of only 2.2% of average glenoid width. © 2015 The Author(s).
    The American Journal of Sports Medicine 04/2015; DOI:10.1177/0363546515581468 · 4.70 Impact Factor
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    ABSTRACT: Little is known about the incidence and characteristics of primary, or external, shoulder impingement in an occupationally and physically active population. A longitudinal, prospective epidemiologic database was used to determine the incidence and risk factors for shoulder subacromial impingement in the United States (U.S.) military. Our hypothesis was that shoulder impingement is influenced by age, sex, race, military rank, and branch of service. The Defense Medical Epidemiology Database was queried for all shoulder impingement injuries using International Classification of Disease, Ninth Addition, Clinical Modification code 726.10 within a 10-year period from 1999 through 2008. An overall injury incidence was calculated, and a multivariate analysis performed among demographic groups. In an at-risk population of 13,768,534 person-years, we identified 106,940 cases of shoulder impingement resulting in an incidence of 7.77/1000 person-years in the U.S. military. The incidence of shoulder impingement increased with age and was highest in the group aged ≥40 years (incidence rate ratio [IRR], 4.90; 95% confidence interval [CI], 4.61-5.21), was 9.5% higher among men (IRR, 1.10, 95% CI, 1.06-1.13), and compared with service members in the Navy, those in the Air Force, Army, and Marine Corps were associated with higher rates of shoulder impingement (IRR, 1.46 [95% CI, 1.42-1.50], 1.42 [95% CI, 1.39-1.46], and 1.31 [95% CI, 1.26-1.36], respectively). The incidence of shoulder impingement among U.S. military personnel is 7.77/1000 person-years. An age of ≥40 years was a significant independent risk factor for injury. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
    Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.] 04/2015; DOI:10.1016/j.jse.2015.02.021 · 2.37 Impact Factor
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    ABSTRACT: Background: Most of the literature on shoulder instability focuses on patients experiencing anterior glenohumeral dislocation, with little known about the treatment of anterior subluxation events. Purpose: To determine the outcomes of surgical stabilization of patients with anterior glenohumeral subluxations and to compare open and arthroscopic approaches. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: We prospectively enrolled patients with anterior glenohumeral subluxations undergoing surgical stabilization. Patients were offered randomization between open and arthroscopic stabilization. Inclusion criteria included patients with anterior glenohumeral subluxations undergoing Bankart repair, while exclusions included the presence of glenoid or humeral bone loss, multidirectional instability, capsular tear/humeral avulsion of the glenohumeral ligament lesion, and rotator cuff tear requiring repair. Patients were randomized to an open Bankart repair through a subscapularis takedown or an arthroscopic Bankart repair, both using the same bioabsorbable suture anchors, and they were followed for a minimum of 2 years. Outcomes were evaluated with the Single Assessment Numeric Evaluation (SANE), Western Ontario Shoulder Instability Index (WOSI), American Shoulder and Elbow Surgeons Score (ASES), Simple Shoulder Test (SST), Rowe, and Tegner activity scores. Results: A total of 26 patients were enrolled, with 7 being lost to follow-up. Complete follow-up data were available on 19 subjects (74%): 10 in the open group and 9 in the arthroscopic group. There were no significant differences noted between the randomized groups, with a 2-year WOSI score of 320 in the open subjects and 330 in the arthroscopic subjects, and similar findings in the other scoring scales. There were no cases of dislocation following surgery. There were 3 patients with recurrent instability (subluxations only) in each group at a mean of 17 months, for an overall recurrent subluxation rate of 31%. These subjects with recurrence had lower outcome scores (WOSI, 532; SANE, 88.4). The outcomes of the 9 subjects with ≤3 subluxation events were superior to those of the 10 subjects with >3 events prior to stabilization. The patients with ≤3 events had a WOSI score of 143, compared with 470 (P = .042), and an ASES mean score of 98.8, compared with 87.1 (P = .048). Four of the 6 patients with recurrent subluxations had sustained >3 subluxations prior to stabilization. Conclusion: Overall, patients with Bankart lesions resulting from an anterior glenohumeral subluxation event had excellent outcomes with surgical stabilization. The overall recurrence in the 19 subjects with at least 2-year follow-up was 6 cases (31%), with no instances of dislocation in this young, active cohort. There was no significant benefit to open or arthroscopic stabilization, and we did find that stabilization of subluxation patients with ≤3 events resulted in superior outcomes compared with chronic recurrent subluxation patients with >3 events. We recommend early surgical stabilization of young athletes with Bankart lesions that result from anterior subluxation events.
    01/2015; 3(1):1-4. DOI:10.1177/2325967115571084
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    ABSTRACT: Background: Activity-related patient-reported outcome measures are an important component of assessment after knee ligament injury in young and physically active patients; however, normative data for most activity scales are limited. Objective: To present reference values by sex for the Marx Activity Rating Scale (MARS) within a young and physically active population while accounting for knee ligament injury history and sex. Study Design: Cross-sectional study. Level of Evidence: Level 2. Methods: All incoming freshman entering a US Service Academy in June of 2011 were recruited to participate in this study. MARS was administered to 1169 incoming freshmen (203 women) who consented to participate within the first week of matriculation. All subjects were deemed healthy and medically fit for military service on admission. Subjects also completed a baseline questionnaire that asked for basic demographic information and injury history. We calculated means with standard deviations, medians with interquartile ranges, and percentiles for ordinal and continuous variables, and frequencies and proportions for dichotomous variables. We also compared median scores by sex and history of knee ligament injury using the Kruskal-Wallis test. MARS was the primary outcome of interest. Results: The median MARS score was significantly higher for men when compared with women (χ2 = 13.22, df = 1, P < 0.001) with no prior history of knee ligament injury. In contrast, there was no significant difference in median MARS scores between men and women (χ2 = 0.47, df = 1, P = 0.493) who reported a history of injury. Overall, median MARS scores were significantly higher among those who reported a history of knee ligament injury when compared with those who did not (χ2 = 9.06, df = 1, P = 0.003). Conclusion: Assessing activity as a patient-reported outcome after knee ligament injury is important, and reference values for these instruments need to account for the influence of prior injury and sex.
    Sports Health A Multidisciplinary Approach 01/2015; DOI:10.1177/1941738115576121
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    ABSTRACT: Purpose The purpose of this study was to summarize the recent developments in the field of tissue engineering as they relate to multilayer scaffold designs in musculoskeletal regeneration. Methods Clinical and basic research studies that highlight the current knowledge and potential future applications of the multilayer scaffolds in orthopaedic tissue engineering were evaluated and the best evidence collected. Studies were divided into three main categories based on tissue types and interfaces for which multilayer scaffolds were used to regenerate: bone, osteochondral junction and tendon-to-bone interfaces. Results In vitro and in vivo studies indicate that the use of stratified scaffolds composed of multiple layers with distinct compositions for regeneration of distinct tissue types within the same scaffold and anatomic location is feasible. This emerging tissue engineering approach has potential applications in regeneration of bone defects, osteochondral lesions and tendon-to-bone interfaces with successful basic research findings that encourage clinical applications. Conclusions Present data supporting the advantages of the use of multilayer scaffolds as an emerging strategy in musculoskeletal tissue engineering are promising, however, still limited. Positive impacts of the use of next generation scaffolds in orthopaedic tissue engineering can be expected in terms of decreasing the invasiveness of current grafting techniques used for reconstruction of bone and osteochondral defects, and tendon-to-bone interfaces in near future.
    Knee Surgery Sports Traumatology Arthroscopy 12/2014; DOI:10.1007/s00167-014-3453-z · 2.84 Impact Factor
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    ABSTRACT: There is no consensus on the optimal treatment of in-season athletes with anterior shoulder instability, and limited data are available to guide return to play.
    The American Journal of Sports Medicine 11/2014; DOI:10.1177/0363546514553181 · 4.70 Impact Factor
  • Brett D Owens
    The American Journal of Sports Medicine 11/2014; 42(11):2557-9. DOI:10.1177/0363546514556637 · 4.70 Impact Factor
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    ABSTRACT: Background: Most surgeons believe that graft choice for anterior cruciate ligament (ACL) reconstruction is an important factor related to outcome; however, graft choice for revision may be limited due to previously used grafts. Hypotheses: Autograft use would result in increased sports function, increased activity level, and decreased osteoarthritis symptoms (as measured by validated patient-reported outcome instruments). Autograft use would result in decreased graft failure and reoperation rate 2 years after revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing revision ACL reconstruction were identified and prospectively enrolled by 83 surgeons at 52 sites. Data collected included baseline demographics, surgical technique, pathologic abnormalities, and the results of a series of validated, patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC], and Marx activity rating score). Patients were followed up at 2 years and asked to complete the identical set of outcome instruments. Incidences of additional surgery and reoperation due to graft failure were also recorded. Multivariate regression models were used to determine the predictors (risk factors) of IKDC, KOOS, WOMAC, Marx scores, graft rerupture, and reoperation rate at 2 years after revision surgery. Results: A total of 1205 patients (697 [58%] males) were enrolled. The median age was 26 years. In 88% of patients, this was their first revision, and 341 patients (28%) were undergoing revision by the surgeon who had performed the previous reconstruction. The median time since last ACL reconstruction was 3.4 years. Revision using an autograft was performed in 583 patients (48%), allograft was used in 590 (49%), and both types were used in 32 (3%). Questionnaire follow-up was obtained for 989 subjects (82%), while telephone follow-up was obtained for 1112 (92%). The IKDC, KOOS, and WOMAC scores (with the exception of the WOMAC stiffness subscale) all significantly improved at 2-year follow-up (P < .001). In contrast, the 2-year Marx activity score demonstrated a significant decrease from the initial score at enrollment (P < .001). Graft choice proved to be a significant predictor of 2-year IKDC scores (P = .017). Specifically, the use of an autograft for revision reconstruction predicted improved score on the IKDC (P = .045; odds ratio [OR] = 1.31; 95% CI, 1.01-1.70). The use of an autograft predicted an improved score on the KOOS sports and recreation subscale (P = .037; OR = 1.33; 95% CI, 1.02-1.73). Use of an autograft also predicted improved scores on the KOOS quality of life subscale (P = .031; OR = 1.33; 95% CI, 1.03-1.73). For the KOOS symptoms and KOOS activities of daily living subscales, graft choice did not predict outcome score. Graft choice was a significant predictor of 2-year Marx activity level scores (P = .012). Graft rerupture was reported in 37 of 1112 patients (3.3%) by their 2-year follow-up: 24 allografts, 12 autografts, and 1 allograft and autograft. Use of an autograft for revision resulted in patients being 2.78 times less likely to sustain a subsequent graft rupture compared with allograft (P = .047; 95% CI, 1.01-7.69). Conclusion: Improved sports function and patient-reported outcome measures are obtained when an autograft is used. Additionally, use of an autograft shows a decreased risk in graft rerupture at 2-year follow-up. No differences were noted in rerupture or patient-reported outcomes between soft tissue and bone-patellar tendon-bone grafts. Surgeon education regarding the findings of this study has the potential to improve the results of revision ACL reconstruction.
    The American Journal of Sports Medicine 10/2014; 42(10):2301-2310. DOI:10.1177/0363546514549005 · 4.70 Impact Factor
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    ABSTRACT: A high signal intensity cleft between the labrum and articular cartilage of the posterior glenoid is commonly visible on MRI and has been suggested to be anatomic variation [3, 10, 23]. The association of a posterior cleft with variations in glenoid morphology or with shoulder instability is unknown.
    HSS Journal 10/2014; 10(3):208-12. DOI:10.1007/s11420-014-9404-x
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    ABSTRACT: Snapping scapula syndrome is a rare condition that presents with symptoms ranging from crepitus to disabling pain in the scapulothoracic articulation. This condition may be more frequent in a military population because of physical fitness standards that require nonphysiologic forces to be applied to the scapulothoracic articulation. Nonoperative therapy is the first-line management. Surgical options include arthroscopic or open scapulothoracic bursectomy with or without partial scapulectomy. After scapulothoracic arthroscopy up to 90% of patients report good/excellent results, up to 90% are able to return to work, and more than 60% return to sports.
    Clinics in Sports Medicine 10/2014; 33(4). DOI:10.1016/j.csm.2014.06.003 · 2.58 Impact Factor
  • Brett D. Owens
    Clinics in Sports Medicine 10/2014; 33(4). DOI:10.1016/j.csm.2014.07.001 · 2.58 Impact Factor
  • Article: Dedication
    Clinics in Sports Medicine 10/2014; 33(4). DOI:10.1016/j.csm.2014.07.002 · 2.58 Impact Factor
  • Kenneth L. Cameron, Brett D. Owens
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    ABSTRACT: Because of the volume of sports-related musculoskeletal injuries experienced by military service members, the US Department of Defense has begun to implement the sports medicine model of care to improve the access, efficiency, and effectiveness of care for solders who experience musculoskeletal injuries related to sports and training. In this article, the burden of musculoskeletal injuries and conditions related to sports and physical fitness training within the military is reviewed, and the application of the sports medicine model to care for these injuries in military service members is described.
    Clinics in Sports Medicine 10/2014; 33(4):573–589. DOI:10.1016/j.csm.2014.06.004 · 2.58 Impact Factor
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    ABSTRACT: While anterior glenohumeral instability has been shown to be common in young athletes, the risk factors for injury are poorly understood.
    09/2014; 42(11). DOI:10.1177/0363546514551149
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    ABSTRACT: There has been increased interest in the number of concussions occurring in college football over the past year. In April 2010, the National Collegiate Athletic Association (NCAA) published new guidelines for the diagnosis and treatment of concussions in student athletes.
    Sports Health A Multidisciplinary Approach 09/2014; 6(5):402-5. DOI:10.1177/1941738113491545
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    ABSTRACT: Military personnel have a greater risk of developing osteoarthritis (OA) than the general population. OA is a chronic, painful, and debilitating disease with a high cost burden. Compared with the general population, a higher prevalence of post-traumatic OA has been reported in the military. Using recent literature, we aim to improve the understanding of post-traumatic OA, with an exploration of the pathophysiology of OA. Our review encompasses the current treatment modalities for alleviating the pain from OA with a focus on viscosupplementation. A multimodal approach may be beneficial for the relief of OA pain and improvement of function in military personnel with early OA, and may lower the cost burden.
    Military medicine 08/2014; 179(8):815-820. DOI:10.7205/MILMED-D-14-00052 · 0.77 Impact Factor
  • 08/2014; 2(2 Suppl). DOI:10.1177/2325967114S00023
  • Source
    AOSSM Annual Meeting, Seattle, WA; 07/2014
  • Arthroscopy The Journal of Arthroscopic and Related Surgery 06/2014; 30(6):e2. DOI:10.1016/j.arthro.2014.04.011 · 3.19 Impact Factor

Publication Stats

3k Citations
376.52 Total Impact Points

Institutions

  • 2006–2015
    • Keller Army Community Hospital
      ვესტ-პოინტი, New York, United States
  • 2014
    • Uniformed Services University of the Health Sciences
      베서스다, Maryland, United States
  • 2008–2014
    • United States Military Academy
      West Point, New York, United States
  • 2008–2013
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 2009–2012
    • University of Colorado
      • Department of Orthopaedics
      Denver, Colorado, United States
    • United States Army
      Washington, West Virginia, United States
  • 2007–2012
    • Tripler Army Medical Center
      Honolulu, Hawaii, United States
    • Duke University
      Durham, North Carolina, United States
  • 2001–2011
    • Walter Reed National Military Medical Center
      • • Department of Orthopaedics and Rehabilitation
      • • Division of Orthopaedic Surgery
      Washington, Washington, D.C., United States
  • 2010
    • The University of Arizona
      • College of Medicine
      Tucson, AZ, United States
  • 2006–2007
    • U.S. Army Institute of Surgical Research
      Houston, Texas, United States
  • 2001–2007
    • University of Massachusetts Medical School
      • Center for Outcomes Research
      Worcester, Massachusetts, United States
  • 2003
    • University of Massachusetts Amherst
      Amherst Center, Massachusetts, United States
    • Dartmouth–Hitchcock Medical Center
      LEB, New Hampshire, United States